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Open AccessPerspective

Sex Hormones and Hormone Therapy during COVID-19 Pandemic: Implications for Patients with Cancer

1
Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132 Genoa, Italy
2
Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), 28029 Madrid, Spain
3
Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy
4
Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(8), 2325; https://doi.org/10.3390/cancers12082325
Received: 5 August 2020 / Accepted: 13 August 2020 / Published: 18 August 2020
(This article belongs to the Special Issue The Impact of COVID-19 Infection in Cancer)
The novel coronavirus disease 2019 (COVID-19) shows a wide spectrum of clinical presentations, severity, and fatality rates. The reason older patients and males show increased risk of severe disease and death remains uncertain. Sex hormones, such as estradiol, progesterone, and testosterone, might be implicated in the age-dependent and sex-specific severity of COVID-19. High testosterone levels could upregulate transmembrane serine protease 2 (TMPRSS2), facilitating the entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into host cells via angiotensin-converting enzyme 2 (ACE2). Data from patients with prostate cancer treated with androgen-deprivation therapy seem to confirm this hypothesis. Clinical studies on TMPRSS2 inhibitors, such as camostat, nafamostat, and bromhexine, are ongoing. Antiandrogens, such as bicalutamide and enzalutamide, are also under investigation. Conversely, other studies suggest that the immune modulating properties of androgens could protect from the unfavorable cytokine storm, and that low testosterone levels might be associated with a worse prognosis in patients with COVID-19. Some evidence also supports the notion that estrogens and progesterone might exert a protective effect on females, through direct antiviral activity or immune-mediated mechanisms, thus explaining the higher COVID-19 severity in post-menopausal women. In this perspective, we discuss the available evidence on sex hormones and hormone therapy in patients infected with SARS-CoV-2, and we highlight the possible implications for cancer patients, who can receive hormonal therapies during their treatment plans.
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Keywords: COVID-19; SARS-CoV-2; estrogens; androgens; progesterone; testosterone; TMPRSS2; ACE2; camostat; androgen-deprivation therapy; tamoxifen COVID-19; SARS-CoV-2; estrogens; androgens; progesterone; testosterone; TMPRSS2; ACE2; camostat; androgen-deprivation therapy; tamoxifen
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MDPI and ACS Style

Cattrini, C.; Bersanelli, M.; Latocca, M.M.; Conte, B.; Vallome, G.; Boccardo, F. Sex Hormones and Hormone Therapy during COVID-19 Pandemic: Implications for Patients with Cancer. Cancers 2020, 12, 2325. https://doi.org/10.3390/cancers12082325

AMA Style

Cattrini C, Bersanelli M, Latocca MM, Conte B, Vallome G, Boccardo F. Sex Hormones and Hormone Therapy during COVID-19 Pandemic: Implications for Patients with Cancer. Cancers. 2020; 12(8):2325. https://doi.org/10.3390/cancers12082325

Chicago/Turabian Style

Cattrini, Carlo; Bersanelli, Melissa; Latocca, Maria M.; Conte, Benedetta; Vallome, Giacomo; Boccardo, Francesco. 2020. "Sex Hormones and Hormone Therapy during COVID-19 Pandemic: Implications for Patients with Cancer" Cancers 12, no. 8: 2325. https://doi.org/10.3390/cancers12082325

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